APR Consulting, Inc. has been engaged to identify a Benefits Specialist
Location: 2480 Natomas Park Drive Suite 150 200 Sacramento, CA 95833
Position: Benefits Specialist
Pay Rate: $23/.92hr
Duration: 35 weeks (8-9 months)
Expected Shift: Schedule (include days & hours anticipated): intermittent hours depending on Open Enrollment assignment(s). Work is on-call and contracted by OE meeting volume(s).
Remote but needs to be local to pick up/drop off benefits materials
POSITION SUMMARY
Prepares, processes, uploads, and maintains new member or group registration information in the enrollment database. Responds to member or group eligibility questions, including verifying enrollment status. reconciling eligibility discrepancies, analyzing transactional data, and submitting retroactive eligibility changes, as needed. Generates various types of member correspondence. Maintains inventory control of member and group transactions.
JOB ACCOUNTABILITIES:
Health Plan Support
- Enters, scans, or updates database information for new enrollments and terminations of group, individual, and ancillary health insurance products, including group employer accounts and individual policy profiles.
- Processes demographic changes to member records, such as name/address/phone/email changes, primary care provider (PCP) changes, etc.
- Handles enrollment or eligibility inquiries from Member Services, including processing duplicate ID card requests, reprinting correspondence, and reordering new member materials.
- Reviews all pending enrollments data for accuracy, analyzes any discrepancies, obtains the correct information, and reconciles the records.
- Identifies performance gaps, recommends and implements approved improvements to enrollment/eligibility processes.
- Responds to all correspondence.
Stakeholder Support
- Communicates with stakeholders (e.g., brokers; customers; vendors) to obtain information and/or clarify concerns based on initial enrollment/eligibility submissions.
- Contacts relevant stakeholders for missing information or incomplete enrollment package to determine availability of the files or forms.
- Reviews enrollment/eligibility submissions (e.g., applications; electronic files) to identify unclear, missing, or validate data, investigates enrollment/eligibility issues or discrepancies.
Data Management
- Submits and reviews test or new eligibility electronic files to ensure the format and accuracy of the loaded information is correct.
- Loads information accurately using working knowledge of relevant file layouts (e.g., flexible spending accounts (FSA), spreadsheet solutions, etc.).
- Uses appropriate computer applications and tools to manage and report enrollment/eligibility information (e.g., Microsoft Access, Excel, structure query language (SQL) server).
- Enters and updates enrollment/eligibility information in the relevant databases and systems.
Compliance
- Adheres to all audit controls, production standards, and regulatory requirements when loading files, resolving eligibility error, or modifying member profiles.
- Maintains strictest confidence of all patients protected health information (PHI) and protects all PHI from accidental, intentional, or inappropriate disclosure.
- Performs and/or reviews audits on enrollment/eligibility information to validate data and to identify areas requiring corrections or modifications.
Collaboration
- Partners with internal and/or external stakeholders (e.g., customers; vendors; brokers; internal teams) to correct errors, issues, or concerns with enrollment/eligibility files or data.
- Works with cross-functional business partners/departments to prep and to ensure open/annual enrollments readiness.
EDUCATION:
- Equivalent experience will be accepted in lieu of the required degree or diploma.
- HS Diploma or equivalent education/experience
TYPICAL EXPERIENCE:
- 1-year recent relevant experience
SKILLS AND KNOWLEDGE:
- General knowledge of health care operations and structure, basic requirements in an integrated delivery system, and the use of information system applications in a health insurance or health care environment.
- Working knowledge of health insurance concepts related to enrollment and eligibility practices.
- Basic familiarity with and understanding of the California Department of Managed Health Care (DMHC) regulations, various health care reimbursement models, pricing mechanisms, managed care and payer relationships.
- Attention to detail with exceptional time management and organization skills with the ability to balance multiple priorities and take appropriate action in challenging situations.
- Analytical, negotiation and project management skills, including the ability to work with diverse people.
- Good attention to detail with time management and organizational skills, including the ability to prioritize assignments and work within standardized policies, procedures, and practices to achieve objectives and meet deadlines.
- Familiarity with relevant file layouts (e.g., Flexible Spending Accounts (FSA), spreadsheet solutions, etc.) for enrollment system uploads.
- Proficient skills with Microsoft Office Suite (Word, Excel, PowerPoint), including a general understanding of database management and data validation techniques.
- Work independently as well as be part of the team, while accomplishing multiple tasks under varied and urgent conditions.
- Identify and evaluate routine or standard problems, then select appropriate solution from established options.
- Ensure the privacy of each patient’s protected health information (PHI).
- Build collaborative working relationships with patients, prospective clients, peers, physicians, other healthcare providers, and vendors to provide exceptional customer service. Diverse individuals and organizations.
This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.
Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.
Don't miss out on this amazing opportunity! If you feel your experience is the match for this position please apply today and join our team. We look forward to working with you!